Provider Demographics
NPI:1639689938
Name:MINDFULNESS BASED INTERVENTIONS LLC
Entity Type:Organization
Organization Name:MINDFULNESS BASED INTERVENTIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MENTAL HEALTH CLINICIAN
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:MOORMAN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:970-318-0529
Mailing Address - Street 1:PO BOX 12
Mailing Address - Street 2:
Mailing Address - City:OURAY
Mailing Address - State:CO
Mailing Address - Zip Code:81427-0012
Mailing Address - Country:US
Mailing Address - Phone:970-318-0529
Mailing Address - Fax:855-403-3931
Practice Address - Street 1:380 SHERMAN ST
Practice Address - Street 2:
Practice Address - City:RIDGWAY
Practice Address - State:CO
Practice Address - Zip Code:81432-5055
Practice Address - Country:US
Practice Address - Phone:970-318-0529
Practice Address - Fax:855-403-3931
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-02
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCSW.00001565261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health